Simulation and analysis of spatio-temporal maps of gastrointestinal motility
© Lammers and Cheng; licensee BioMed Central Ltd. 2008
Received: 03 October 2007
Accepted: 14 January 2008
Published: 14 January 2008
Spatio-temporal (ST) maps provide a method for visualizing a temporally evolving and spatially varying field, which can also be used in the analysis of gastrointestinal motility. However, it is not always clear what the underlying contractions are that are represented in ST maps and whether some types of contractions are poorly represented or possibly not at all.
To analyze the translation from stationary or propagating rhythmic contractions of the intestine to ST maps, a simulation program was used to represent different patterns of intestinal contraction and to construct their corresponding ST maps. A number of different types of contractions were simulated and their ST maps analyzed.
Circular strong contractions were well represented in ST maps as well as their frequency and velocity. Longitudinal contractions were not detected at all. Combinations of circular and longitudinal contractions were, to a limited extent detectable at a point in space and time. The method also enabled the construction of specific ST-patterns to mimic real-life ST maps and the analysis of the corresponding contraction patterns.
Spatio-temporal simulations provide a method to understand, teach and analyze ST maps. This approach could be useful to determine characteristics of contractions under a variety of circumstances.
Spatio-temporal (ST) maps provide a method for visualizing a temporally evolving and spatially varying field. In the gastrointestinal system, they were first used in 1997 TheyTheyto analyze intestinal motility . To date, this type of analysis, also called D-maps (the D refers to the diameter), has been used to analyze the motility of the small intestine [2–4], colon , stomach , or of barium contents . In most of these studies, recordings were obtained from experiments performed in vitro but recently in vivo recordings have also been obtained [8, 9].
However, it is uncertain what a spatio-temporal map (ST map) may entail. For example, it is not certain what types of contraction are detected and how faithfully they can be represented by the ST maps or whether there is a bias for particular types of contractions. One way to start addressing these uncertainties is to use a simulation program, which allows systematic investigation of a number of different types of intestinal contractions, such as stationary or propagating segmental or pendular contractions, and to generate the corresponding ST maps. By comparing the original, albeit artificial, contractions with the derived ST map, it is possible to clarify some of the potentials and limitations of ST mapping.
In the first simulation (Figure 1), a single contraction occurred on both sides of the intestinal tube that constricted the lumen to 10% of its original value. The contraction propagated from left to right and, at this moment during the simulation, was located in the middle of the preparation. In panel 2, the diameter of the tube was calculated along its length and, for this time step, translated, as is the custom in ST mapping, in a single line whereby the value for the diameter was converted into the intensity of the line (panel 3). Black shading corresponded to an open tube (100%) whereas white shading represented a fully occluding contraction (0%).
Therefore, at this particular moment during the simulation, the "intensity line" was black along the length of the segment except for a middle portion that was white to light grey, indicating contraction in that area. This line was then stacked on top of previous lines obtained from previous time steps (panel 4). At the end of this simulation, in which two uniformly propagating contractions occurred after each other, two parallel white lines were obtained in the ST map. The angle of these lines indicates the direction and the velocity of the contraction while the vertical distance (time) between the lines is a measure of the frequency of this contraction.
In the ST maps presented in this article, time was oriented upwards in the vertical direction and space in the horizontal direction as is the convention of some groups [4, 8]. However, it should be noted that there are alternative conventions to orientate time in the horizontal direction [1, 3] or in the downward vertical direction [2, 5].
A series of different controlled contraction types were systematically analyzed by varying a number of parameters that affected the motility patterns of intestine and examining the corresponding ST maps.
Variations in velocities
Stationary and propagating oscillating contractions
In the small intestine, one of the most common types of contraction is the pendular contraction. This pendular contraction reflects the rhythmic contractions of longitudinal muscles that occur at the rhythm of the slow wave . As analyzed and simulated by Melville et al. , this contraction, in itself, does not narrow the lumen. Therefore, as the inner diameter does not change, there are no resulting imprints in the ST maps, and this type of contraction occurring by itself remains invisible. Indirectly however, it could be possible to detect these pendular contractions if and when other circular contractions occur on top of the longitudinal contractions. This was analyzed in the following simulation.
The effects of the curvature of the segment
The ST maps were initially simulated with a regular burst of occluding contractions (panel B). The size of the imprints was best resembled by setting the width of the contractions at 70% of the distance between neighboring contractions. This produced an ST map (panel B) in which the width and the frequency of the individual contractions resembled those in the original record. The contractions also propagated in the aboral direction as indicated by arrow 'a'. The propagation speed was adjusted to produce a slope similar to slope 'a' in the inset. In addition, a second arrow 'b' was drawn connecting the neighboring contractions. The slope of this arrow was horizontal as all contractions occurred simultaneously. As the slope of arrow 'b' in the inset was obviously not horizontal, it was concluded that neighboring contractions did not occur simultaneously. Several scenarios were tested as shown in panel C. In these simulations, the contractions again propagated while oscillating at the same frequency. The timing of neighboring contractions was then offset with respect to each other. In panel C1, the contraction started at '1', was complete at '2' and relaxed at '3'. The slope of arrow 'b' was therefore towards the aboral direction. This was however opposite to that measured in the inset. If the contraction sequence was reversed (scenario C2) then the correct slope was obtained. In the original paper that described this recording , it was assumed that propagation actually was retrograde (white arrow in the duodenum in panel A). This was tested in scenarios C3 and C4 in which the propagation was in the oral direction and the contraction sequence took place in either the oral or in the aboral direction. From this analysis, it would now seem that the contraction propagation was actually in the aboral direction while the sequence of contractions occurred in the oral direction.
This analysis has shown some of the potentials and limitations of spatial-temporal mapping of intestinal contractions. ST mapping is at its best in determining origin and direction of fully occluding circular contractions. In several cases, the frequency, velocity and width of strong circular contractions can be measured accurately. On the other hand, contractions of the longitudinal muscle layer, as in pendular contractions, are not detected at all (Figure 4). Combinations of circumferential and longitudinal contractions can partly be reconstructed depending on their corresponding propagations and frequencies (Figure 3). Finally, this approach also presents the potential of inverse analysis of real-life ST maps and the characterization of the underlying contraction patterns (Figure 6).
In many cases, video recordings of the intestinal tube are used to measure the diameter of the segment and in most cases; it is the outer diameter, not the inner luminal diameter, that is used for the construction of ST maps. In smaller animals with thin luminal walls, the difference between the two might be negligible, but, in larger animals and in humans, this difference may become significant. Another approach has been to use the variations in contrast in computer-enhanced images as a way to obtain signals suitable for ST analysis . However, the relation between contrast, contraction and diameter has not been evaluated. For example 'contrast' recordings may also be able to pick up longitudinal contractions that diameter recordings may miss. Finally, especially in in vivo fluoroscopy studies, it is often not the intestinal wall but the intestinal contents that are measured [7, 13]. It is known that changes in luminal content do not necessarily reflect muscular contractions  but the effects a local contraction may have on luminal contents located further away have not been analyzed.
Nevertheless, within these constraints, ST mapping is a useful tool to detect and characterize intestinal contractions, provided that its limitations are known. Together with other techniques, such as intra-luminal pressure recordings, impedance measurements of intestinal flow and myo-electrical recordings, it contributes to our increasing knowledge of normal and abnormal intestinal behavior.
Simulations of intestinal contractions and the creation of corresponding spatio-temporal maps (ST maps) have shown that some types of contractions, especially circular contractions, are well represented in ST maps while others, especially contractions of the longitudinal muscle coat, are not detected by ST maps at all. Combinations of circular and longitudinal contractions can, to a certain extent, be detected. This approach also enables the construction of specific ST-patterns to mimic real-life ST maps and the analysis of the underlying contraction patterns.
This word was funded in part by the Faculty of Medicine & Health Sciences, UAE University, Al Ain, United Arab Emirates and a National Institutes of Health research grant (R01 DK64775). The second author was grateful for support via a Claude McCarthy Fellowship.
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